tbuckley/cabot-search huggingface dataset:
AB0266 THE INFLUENCE OF HEREDITY ON RHEUMATOID ARTHRITIS: EXAMINING THE DISTINCT CHARACTERISTICS IN PATIENTS WITH A FAMILY HISTORY
Authors: H. EL-Kasmi, N. Akasbi, I. El Mezouar, M. Omari, T. Harzy
Journal: Annals of the Rheumatic Diseases (2023)

<h3>BACKGROUND:</h3> NIL. <h3>Objectives</h3> The aim of this study was to describe the particularities of patients diagnosed with rheumatoid arthritis (RA) who have a family history of the disease. <h3>Methods</h3> In this retrospective study, a total of patients diagnosed with RA between the years 2011 and 2022 were included. The primary aim of the study was to investigate the relationship between different parameters such as age of disease onset, Disease Activity Score using C-reactive protein(DAS CRP), serological profile, erosive character,extra-articular manifestations, and use of biotherapy. Data were collected from the medical records of the patients, and analyzed using statistical test such chi-squared, Fisher's exact test and t-test.the level of significance was set at p=0.05.the study design included a thorough data cleaning process. <h3>Results:</h3> The study included 407 patients with a mean age of 58.86 years ± 12.441, and a sex ratio of 6 (F/M). The median duration of the disease was 14 ± 7.523 years. Erosions were found in 87.2% of patients. Rheumatoid factor (RF) was positive in 85% of patients and anti-citrullinated protein antibodies (ACPA) were positive in 64.9% of patients. The mean DAS 28 score was 5.409± 2.52, the mean CRP was 33.84±35.19, and extra-articular manifestations were found in 46.4% of patients and 39.1% of patients were receiving biological treatment. 21 patients (5.17%) reported a family history of RA. In bivariate analysis, RA patients with a family history had more extra-articular manifestations compared to patients without a family history of the disease (66.7%) versus (46.3%) (p =0.05). No association was found for the other parameters. <h3>Conclusion</h3> The results of this study suggest that a family history of RA may be a predictive factor for extra-articular manifestations in patients with the disease. These findings highlight the importance of considering family history when evaluating and treating patients with RA. Further research is needed to confirm these results and to better understand the underlying mechanisms. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB1621 REFERRAL BEHAVIOUR OF PRIMARY CARE DOCTORS TO RHEUMATOLOGY CLINIC IN MALAYSIA
Authors: C. R. Ng
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The workload at rheumatology clinics have been growing relentlessly and an audit on new. referrals helps to identify referral behaviour of primary care doctors and improvement can be done by providing further training. <h3>Objectives</h3> To audit on new referral cases to rheumatology clinic from 2020-2022 and to identify new cases with misdiagnosis for future training purpose. <h3>Methods</h3> This was a retrospective study. The medical records of all new referral to rheumatology clinic Hospital Sultan Ismail and Hospital Pakar Sultanah Fatimah from 1st January 2020 to 31th November 2022 were reviewed. The referral diagnosis and final diagnosis were identified and analysed. <h3>Results</h3> There were total of 927 new cases referral throughout the 35 months during Covid-19 pandemic. Majority of them were diagnosed to have rheumatoid arthritis (217/927) followed by systemic lupus erythematosus (190/927), psoriatic arthritis (147/927), gout (62/927), osteoarthritis (58/927), systemic sclerosis (25/927), ankylosing spondylitis (25/927), soft tissue rheumatism (24/927), Sjogren syndrome (24/927), mixed connective tissue disease (14/927), vasculitis (11/927), fibromyalgia (10/927), polymyositis (7/927) and miscellaneous (39/927). 45 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 29 pending cases awaiting final diagnosis. 212 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis. (55/212) followed by unlikely rheumatic disease (43/212), soft tissue rheumatism (24/212), psoriatic arthritis (20/212), Sjogren syndrome (14/212), gout (8/212), rheumatoid arthritis (7/212), fibromyalgia (6/212), systemic lupus erythematosus (5/212), ankylosing spondylitis (4/212), mixed connective tissue disease (3/212), systemic sclerosis (2/212), polymyositis (2/212) and others (19/212): diffuse idiopathic skeletal hyperostosis, hypermobility syndrome, RS3PE syndrome, idiopathic uveitis, graft versus host disease, juvenile idiopathic arthritis, antiphospholipid syndrome, hypothyroidism, post streptococcal arthritis, prolapsed intervertebral disc, cerebrovascular disease, traumatic sternoclavicular joint subluxation, ledderhose disease, paraspinal muscle spasm and viral myalgia). <h3>Conclusion</h3> Nodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory. arthritis and if wrongly diagnosed will lead to unnecessary anxiety or wrong treatment. More training is needed to improve clinical skills amongst primary care doctors. <h3>References</h3> NA. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0944 COMORBIDITIES IN THE SPONDYLOARTHRITIS GISEA COHORT: AN AVERAGE TREATMENT EFFECT ANALYSIS ON PATIENTS TREATED WITH BDMARDS
Authors: L. Scagnellato, A. Collesei, G. Cozzi, M. Lorenzin, A. Doria, G. Lapadula, R. Ramonda
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The treatment of Spondyloarthritis (SpA) has enormously improved thanks to bDMARDs, which are usually safe but they still require some caution because of their interference with the immune system homeostasis. ATE is a still evolving method designed to study the causal relationship between treatment and outcome. <h3>Objectives</h3> We endeavoured to investigate the impact of TNF-inhibitors (TNFi), anti-interleukin17 or interleukin12/23 monoclonal antibodies (anti-IL) on comorbidities among SpA patients enrolled in the Italian GISEA Registry, using an average treatment effect (ATE) analysis. <h3>Methods</h3> SpA patients from the GISEA Registry were divided into groups according to pharmacological exposure: no treatment (G0), TNFi (G1) and anti-IL (G2). In each group, the prevalence and incidence of infectious, cardiopulmonary, endocrinological, non-inflammatory gastrointestinal disease (NIGID), oncologic, renal and neurologic comorbidities were evaluated. Thus, each comorbidity was fitted for ATE and baseline features were evaluated for importance. <h3>Results</h3> This multi-centre Italian GISEA study comprised 4458 SpA patients (G0=495 patients, G1=3113 patients, G2=815 patients). Cardiovascular disease was the most prevalent and incident comorbidity in all groups, with no significant difference between groups. ATE showed no increased risk of solid cancer in G1 and G2 (G1 vs. G0 = 0,42 95% CI 0,20-0,85; G2 vs. G0 = 0,26 95% CI 0,08-0,71), but significantly higher prevalence and incidence in G0 (14.07/1000 patient-years, p=0,0001). Conversely, a significantly higher risk of NIGID and fibromyalgia was found in G1 and G2 vs. G0 (NIGID: G1 vs. G0 =1.56 95% CI 1.06-2.33, G2 vs. G0 =1.91 95% CI 1.05-3.24; fibromyalgia: G1 vs. G0 1.69 95% CI 1.05-2.68, G2 vs. G0 2.13 95% CI 1.14-3.41). No treatment risk modification was observed concerning haematological malignancies, cardiovascular events and endocrinological comorbidities. <h3>Conclusion</h3> Overall, this study reveals that bDMARDs have only a slight interference of the occurrence of comorbidities in SpA patients, underlining the appropriateness of the use of bDMARDs in current clinical practice. Some caveats pertain to NIGID and fibromyalgia. Importantly, causality may yield more reliable and relevant clinical information, flattening the unbalance between observational data and clinical trials. <h3>Acknowledgements</h3> Roberta Ramonda and Giovanni Lapadula are part of the GISEA Working Group, comprising the Centre of Centre of Bari, Milan (Presidio Ospedaliero Gaetano Pini), Brescia, Catania, Foggia, Rome (Policlinico Umberto I, Policlinico Gemelli and Policlinico Tor Vergata), Cagliari, Modena, Verona, Turin (Azienda Ospedaliero-Universitaria Città della Salute and Ospedale Mauriziano Umberto I), Siena, Pavia, Messina, Ferrara and Padova. <h3>Disclosure of Interests</h3> None Declared.
POS1505 THE IMPACT OF HIGH-RISK ANTIPHOSPHOLIPID ANTIBODIES PROFILE ON MAJOR ORGAN DAMAGE PROGRESSION IN SYSTEMIC LUPUS ERYTHEMATOSUS: CSTAR MULTIPLE PROSPECTIVE COHORT STUDY
Authors: D. Yufang, J. Zhao, Q. Wang, X. Tian, M. LI, X. Zeng
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> With the improvement in survival, the prevention of cumulative organ damage has become a major goal in the management of systemic lupus erythematosus (SLE). Patients with autoimmune disease suffered from an increasing risk of cardiovascular disease (23·3 events per 1000 patient-years <sup>[1]</sup>). Although antiphospholipid (aPLs) antibodies, including anticardiolipin antibodies, anti-<i>β</i>2 glycoprotein I, and lupus anticoagulant, were associated with vascular events in antiphospholipid syndrome, the role of APLs in SLE patients was not yet determined. <h3>Objectives</h3> Based on the Chinese SLE treatment and research (CSTAR) multi-center prospective study, we aimed to identify the predictive value of high-risk aPLs on cumulative organ damage progression in SLE. <h3>Methods</h3> Demographic characteristics, autoantibody profiles, clinical manifestations, disease activity status, and organ damage were collected at baseline. High-risk aPLs profile was defined according to 2019 EULAR recommendations for APS <sup>[2]</sup> (the presence of lupus anticoagulant, or double or triple aPL positivity, or the presence of persistently high aPLs titers). <h3>Results</h3> A total of 2132 SLE patients with full follow-up data were recruited and 424 (19.9%) showed high-risk aPLs profiles. 453 (21.2%) patients developed new organ damage during a mean follow-up of 4.40±2.64 years, and 143(31.6%) are cardio-cerebral vascular damage. At baseline, patients with high-risk aPLs profile have a higher rate of neurological involvement (12.5% vs 7.6%, p=0.001). As shown in Figure 1, cox regression analysis showed that high-risk aPLs profile can predict new-onset organ damage (HR=1.99, 95% CI, 1.63-2.43, p&lt;0.001) and cardio-cerebral vascular damage (HR=7.83, 95% CI, 5.56-11.03, p&lt;0.001). After adjusted of gender(male), age, smoking history, diabetes mellitus, hypertension, and other SLE related potential confounders, high-risk aPLs profile was still found to be an independent predictor which can predict cardio-cerebral vascular events (HR=7.12, 95% CI, 5.03-10.14, p&lt;0.001) (Figure 1). <h3>Conclusion</h3> SLE patients with high-risk aPLs profile warrant more care and surveillance of cardio-cerebral vascular events during follow-up. <h3>References</h3> [1] Conrad N, et al. Lancet 2022;400(10354):733-43. [2] Tektonidou MG, et al. Ann Rheum Dis 2019;0:1–9. <h3> Acknowledgements</h3> We thank CSTAR co-authors as following for assistance with cases collections. <h3>Disclosure of Interests</h3> None Declared.
AB0984 SACROILIAC MRI FINDINGS IN PATIENTS WHO WERE REQUESTED A SACROILIAC STUDY: SACROILIITIS AND OTHER DIAGNOSES
Authors: R. Almodovar González, A. Bueno, P. Zarco-Montejo, C. López-Medina, A. Benito Ysamat, J. F. Garcia Llorente, F. Diez Renovales, O. Casado Verdugo, M. Moreno, M. Llop Vilaltella, L. Berrocal, A. Marin, C. Fernández-Carballido, C. Crespo, X. Juanola-Roura, J. A. Narvaez, E. Dieguez Costa, R. Mazzucchelli
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Magnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of sacroiliitis. Diagnosing sacroiliitis on MRI is not always straightforward and can be challenging in some cases. <h3>Objectives</h3> To evaluate the prevalence of sacroiliitis (according to ASAS criteria) and other diagnoses in sacroiliac MRI. To analyse/compare these diagnoses by sex, age and service requesting the study. <h3>Methods</h3> This is a cross-sectional, multicentre, descriptive, retrospective study in a hospital and/or specialised care setting. Consecutive MRI examinations (in adults) of the sacroiliac joints (SIJ) performed between 1 de Enero de 2019 y el 31 de Diciembre del 2019 were retrospectively evaluated for the presence of structural and active sacroiliitis findings according to the Assessment of SpondyloArthritis International Society guidelines. Alternative diagnoses, including degenerative changes, diffuse idiopathic skeletal hyperostosis (DISH), osteitis condensans ilii (OCI), septic sacroiliitis/discitis, stress reaction and anatomic variants, were registered. <h3>Results</h3> We evaluated 1,283 MRI examinations, 526 (41%) males, average age 46.7 ± 14 years. 71.6% of the requests are from the Rheumatology service, 15.8% from Orthopedic Surgery and Traumatology and 12.5% from other services. 70% of the MRIs were reported by a radiologist expert in the locomotor system. Findings suggestive of axial spondyloarthritis were found in 353 (27.5%). Sacroiliitis was found in 71 examinations (25%) and alternative diagnoses were suggested in 87 (31%) (OCI 8.9%, anatomic variants 5.3%, septic sacroiliitis/discitis 5.3%, degenerative findings 4.3%, DISH 1.5%, stress reaction 0.7%, tumor 0.3%). A normal examination was found in the remaining 123 examinations. Patients with alternative diagnoses were older than those with sacroiliitis (62 vs. 47 years of age, respectively, P &gt; 0.05). Alternative diagnoses in the SIJ were significantly more common in females (66) than in males (21), P &lt; 0.05. <h3>Conclusion</h3> A substantial proportion of patients with suspected sacroiliitis had normal SIJ while the rest were more commonly diagnosed with pathologies other than inflammatory sacroiliitis. A referral by an experienced rheumatologist may improve the sensitivity and specificity of this important examination. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS1568 ANAKINRA TREATMENT IN COLCHICINE RESISTANT PERICARDITIS: A SINGLE CENTER EXPERIENCE
Authors: Z. Toker Dincer, E. Yilmaz, M. B. Ates, O. Corbali, S. Ugurlu
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Recurrent pericarditis (RP) may be encountered in autoinflammatory diseases, such as familial Mediterranean fever (FMF), however, the etiology stands principally unknown <sup>[1]</sup>. Alternative treatments have been suggested for the treatment of colchicine-resistant cases whether idiopathic or related to FMF <sup>[2]</sup>. <h3>Objectives</h3> This study describes our experience of anakinra treatment for colchicine-resistant pericarditis cases. <h3>Methods</h3> All patients with pericarditis followed in our center who received anakinra since 2014 were evaluated retrospectively. Relevant data were retrieved from archives and verified with telephone interviews. Therapeutic efficacy, as well as the side effect profile, of anakinra was assessed. <h3>Results</h3> Our series consists of 15 patients (10 males, 5 females) with colchicine-resistant pericarditis whose demographic, clinical, and treatment features are given in Table 1. The mean age was 38.9±15.9. 6 cases were secondary to FMF and the remaining were idiopathic other than one perimyocarditis and one multisystem inflammatory syndrome in adults. Two of all patients whose autoinflammatory genetic panels were screened were detected to carry FMF mutations K695R het. and E148Q. The median follow-up duration was 53 months (range 10-174); the median number of recurrences before anakinra was 4 (range: 1-14). Ten patients (66.7 %) experienced no episode of pericarditis (mean episode count: 0.86) during anakinra treatment. Corticosteroids were discontinued in all patients except one transplant recipient. The anakinra dose of those who progressed attack-free was tapered without relapse in 5 cases, whereas 7 cases relapsed after tapering. Currently, 11 patients carry on anakinra treatment, while 3 patients stopped anakinra since remission was achieved. No side effect of anakinra was observed, with the exception of skin reaction in two patients. <h3>Conclusion</h3> Anakinra was found to be a safe and effective agent against colchicine-resistant pericarditis, notably recurrent pericarditis. Long-term treatment should be anticipated when initiating treatment and dose tapering should be kept in mind for patients in remission. Relapses should be watched for attentively in tapering and anakinra should be resumed promptly in case of a recurrence. Furthermore, anakinra is important in sparing cortisol treatment. <h3>References</h3> [1]Imazio, M., Gribaudo, E., &amp; Gaita, F. (2017). Recurrent Pericarditis. <i>Progress in cardiovascular diseases</i>, <i>59</i>(4), 360–368. [2]Imazio M. (2021). Clinical Trials in Pericardial Disease: New Paradigm Shift. <i>Current cardiology reports</i>, <i>23</i>(11), 170. <h3> Acknowledgements</h3> None. <h3>Disclosure of Interests</h3> None Declared.
POS1045 HISTOLOGICAL COMPOSITION OF (TENO)SYNOVIAL AND SYNOVIAL INFLAMMATION IN RHEUMATOID ARTHRITIS ACROSS DISEASE PHASES
Authors: L. A. Coletto, C. Tur, P. Rubortone, L. Verardi, C. DI Mario, B. Tolusso, L. Petricca, M. R. Gigante, M. Gessi, M. A. D’agostino, M. M. Lizzio, S. Alivernini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Subclinical tenosynovitis arose as a primary sign of inflammation already in the pre-clinical phases of Rheumatoid Arthritis (RA) and tenosynovitis is a common feature of active state and might persist although sustained remission is achieved. <h3>Objectives</h3> To assess the histological features of (teno)synovium from the extensor digitorum tendons of the hand across RA trajectory and to compare it with paired synovial tissue samples. <h3>Methods</h3> Thirty-seven patients underwent minimally invasive ultrasound (US)-guided biopsy of the tenosynovium of extensor digitorum tendons [n=16 with clinically suspected arthralgia (CSA), n=19 with RA (n=4 naïve, n=6 resistant to csDMARDS, n=8 to bDMARDs, and n=1 in sustained remission respectively)]. Twenty-three out of 37 patients presenting CSA or clinically evident synovitis in a peripheral joint (whether anatomically adjacent or not to the tendon of interest) underwent US-guided synovial tissue (ST) biopsy also in that location. The Krenn synovitis score (KSS) and the inflammatory infiltrate using CD68/CD21/CD3/CD20 immunohistochemical (IHC) analysis were assessed for each sample. <h3>Results</h3> Tenosynovium belonging to the extensor digitorum compartment of the wrist was successfully collected using a minimally invasive US-guided technique that enabled to retrieve representative samples in terms of lining and sublining layers presence in 86.5% and 100% of cases, respectively. Considering the pre-arthritis subgroup, KSS was similar in ACPA/RF<sup>pos</sup> vs ACPA/RF<sup>neg</sup> CSA (p=0.5814) and KSS was contingent with RA activity, being significantly higher in naïve or resistant RA (ANOVA p&lt;0.001) compared to CSA. Moreover, the comparison between (teno)synovial and synovial tissue paired samples from two adjacent anatomical locations revealed a similar KSS value (p&gt;0.999) and IHC showed comparable enrichment in terms of lining and sublining CD68<sup>pos</sup>, sublining CD20<sup>pos</sup> and CD3<sup>pos</sup> cells (for all comparisons p&gt;0.05) between the two sites, in naive and c- or b-DMARDs resistant RA patients. The procedure was well tolerated, and no tendon injury occurred within 10 months follow-up. One patient developed local hematoma that recovered after topic treatment. <h3>Conclusion</h3> (Teno)synovium is a retrievable tissue through a minimally invasive procedure across RA trajectory and its inflammation is directly related to the disease state. Semiquantitative analysis showed comparable inflammatory degree and inflammatory cellular composition in adjacent anatomical sites of the same person. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS1251 TREATMENT TAPERING IN SYSTEMIC SCLEROSIS: A 10-YEAR FOLLOW-UP STUDY
Authors: J. Ciaffi, S. Liem, N. Van Leeuwen, C. Allaart, T. Huizinga, J. De Vries-Bouwstra
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In systemic sclerosis (SSc), tailoring treatment to each patient's needs is challenging and it is unclear whether and how patients need to be treated in the long-term. The feasibility of tapering and even withdrawing immunosuppressive therapies in patients with stable disease is still an open question. <h3>Objectives</h3> Using data from the Leiden SSc cohort, our aim was to describe how often treatment is modified during a follow-up period of 10 years, with a special interest in the possibility of tapering immunosuppressors (i.e. either tapering the dosage or switching to a less immunosuppressive regimen). <h3>Methods</h3> We analyzed the use and changes of immunosuppressive therapies in the whole cohort and in patients stratified for sex and autoantibody status. We included 708 SSc patients with at least one visit performed between 2009 and 2021, accounting for 2968 visits. <h3>Results</h3> At the time of referral to the care pathway, 31% of patients were receiving immunosuppressors and tapering was possible in 8% of them (Table 1). During the follow-up, tapering was possible in a higher proportion of patients treated with immunosuppressive medications, up to the 20% at the third-year and 26% at the sixth-year visits. No significant differences emerged in the proportions of drug tapering between males and females or between patients with anticentromere and anti-topoisomerase I antibodies. Overall, immunosuppressive medications were tapered 137 times during the 2968 visits. Of the 107 patients who tapered medications at least once during the follow-up, in 64% of cases it happened during the first three years. In 24 patients, tapering occurred at the last available visit, whereas in 83 patients the management of medications could be evaluated after tapering (246 follow-up visits). In 31 cases, therapies were not changed further. In the other 52 patients, treatment regimen was modified again and in 31 cases we had to either increase the dosage of the current therapy or to initiate a new immunosuppressive drug. Analysing the type of immunosuppressive medication used (Figure 1), we observed that treatment with methotrexate tended to decrease, while mycophenolate mofetil gained favour over the years, especially in women and in patients with anti-topoisomerase I antibodies. <h3>Conclusion</h3> In conclusion, tapering of immunosuppressors could be considered in 15% of cases (107 of 708) in our large prospective cohort, and this was succesful in approximately two-thirds of cases in which follow-up was available (52 out of 83). If on the one hand early therapeutic intervention might be beneficial and a window of opportunity exists in SSc, on the other hand tapering immunosuppressive treatments might become feasible in a proportion of patients with stable disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.